The effect of preoperative sublingual buprenorphine on postoperative pain after lumbar discectomy: A randomized controlled trial

Abstract

Background Lumbar discectomy is one of the most common surgical procedures performed to manage pain caused by the protrusion of an intervertebral disc. Postoperative pain management can be challenging and might lead to increased intake of opioids. Objective : The aim of this study was to determine the effect of preoperative sublingual buprenorphine on severity of pain after lumbar disc surgery and postoperative intake of morphine. Methods This Randomized clinical trial study was performed on 78 patients who were selected for lumbar discectomy surgery. Patients were randomly divided into two groups of 39 patients, each. Patients in the buprenorphine and placebo group received 2 mg buprenorphine sublingual, and placebo 1 h before surgery. Severity of pain, nausea, vomiting and pruritus and intake of opioids in the two groups were evaluated and recorded 1, 6, 12 and 24 h after surgery. Data were analyzed using SPSSv21. Results There was a significant difference in pain score in buprenorphine group at 1, 6, 12, and compared with placebo (P < 0.005). In the control group, the use of analgesics was more than the buprenorphine group. In the first hours after surgery (1–6 h), the incidence of nausea in the buprenorphine group was significantly lower than of the control group (P < 0.05). However, at 12 and 24 h, this difference was not observed, p > 0.05. There was no significant difference in incidence of side effects (nausea, vomiting, pruritus) in the two groups (P > 0.05). Conclusion Sublingual buprenorphine in postoperative pain management is an effective and low dose drug. Due to its simpler administration, it is recommended to relief postoperative pain after lumbar disc surgery.

The Efficacy of Buprenorphine in Preoperative and Postoperative Patients: A Literature Review

“…However, this change was not seen at 12 or 24 h, p > 0.05. The incidence of adverse effects (nausea, vomiting, and pruritus) was not significantly different between the two groups (P > 0.05) [13].…”

Current and Future Therapeutic Options in Pain Management: Multi-mechanistic Opioids Involving Both MOR and NOP Receptor Activation

“…Sublingual buprenorphine was also assessed in the perioperative setting [ 93 ]. Sublingual buprenorphine has a 60-min time to reach the maximum plasma concentration, a 11.2 h half-life, and a 35% bioavailability, and is actually approved for opioid withdrawal, but not for chronic pain management [ 84 ].…”

Letter: What Neurosurgeons Need to Know About Perioperative Buprenorphine for Opioid Use Disorder

“…7 Buprenorphine is an important aid in pain control for patients who are being prescribed this medication and has even been used for postoperative neurosurgical patients for pain control in those without opioid use disorder. 8,9 For patients prescribed buprenorphine, a retrospective cohort suggests that continuing buprenorphine is associated with lower opioid requirements for analgesia: Patients who continued buprenorphine required lower doses of intravenous patient-controlled anesthesia opioids when compared with patients who did not receive buprenorphine on the day after surgery. 10 Further evidence toward buprenorphine aiding in pain control was described in a cohort study of obstetric patients undergoing cesarean section, which found that patients treated with buprenorphine had similar mean opioid requirements to patients treated with methadone, a full opioid agonist.…”